Thrombectomy is an effective treatment for acute ischemic stroke (AIS). The aim was to compare clinical outcomes with intracranial artery occlusion site among AIS patients treated in the setting of a cardiology cath-lab.
Single center, prospective registry of 214 consecutive patients with AIS enrolled between 2012 and 2018. All thrombectomy procedures were performed in a cardiology cath-lab with stent retrievers or aspiration systems. The functional outcome was assessed by the modified Rankin scale (mRS) after 3 months. Ninety-three patients (44%) had middle cerebral artery (MCA) occlusion, 28 (13%) proximal internal carotid artery (ICA) oclussion, 27 (13%) tandem (ICA+MCA) occlusion, 39 (18%) terminal ICA (T-type) occlusion and 26 (12%) vertebrobasilar (VB) stroke. Favorable clinical outcome (mRS ≤ 2) was reached in 58% of MCA occlusions and in 56% of isolated ICA occlusions, but only in 31% of T-type occlusions and in 27% of VB stroke. Poor clinical outcome in T-type occlusions and VB strokes was influenced by the lower recanalization succes (mTICI 2b-3 flow) rates: 56% (T-type) and 50% (VB) compared to 82% in MCA occlusions, 89% in isolated ICA occlusions and 96% in tandem occlusions.
Catheter-based thrombectomy achieved significantly better clinical results in patients with isolated MCA occlusion, isolated ICA occlusions or tight stenosis and tandem occlusions compared to patients with T-type occlusion and posterior strokes.